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What injuries stop a soldier from going into combat?

March 20, 2012 | 9:30
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Robert Bales, the U.S. staff sergeant suspected of killing 16 Afghan civilians, reportedly suffered a concussive head injury on an earlier tour in Iraq. But his attorney says he was found suitable for redeployment. What kind of injuries stop a member of the Army from being sent into combat again?

The rules are lengthy and complicated. Medical problems stop some people from heading into combat in the first place: Before they enlist, U.S. Army soldiers are screened by physicians hired by the military.

Soldiers can be kept out of the armed forces for a long list of medical issues, including skull deformities that prevent them from wearing a helmet or protective mask, a history of emphysema, being HIV-positive, even an inability to clench a fist. Some head injuries can count someone out of the Army, including injuries that cause "persistent impairment of cognitive function," or altered personality.

So can some kinds of anxiety or depression, depending on how serious the problem is. "Transvestism" can keep someone out of the military, as can a history of suicidal behavior or alcohol or drug abuse. The most common thing that keeps people out -- and a growing problem for recruiters –- is weight.

However, the Army can choose to waive these and other requirements. Waivers tend to become more common when recruiting is tough, said Beth Asch, a senior economist at the RAND Corp. think tank. For instance, between 2001 and 2007, waivers rose from 12% to 20% of recruits. Now that the economy is weak, recruiting is easier, which means waivers are likely less common, Asch said.

Once a soldier is screened and has enlisted, he is assessed by a healthcare provider before going into combat. After a soldier comes back and is going to be deployed again, he undergoes another screening, said Maria Tolleson, media relations officer for the Office of the Army Surgeon General.

That is supposed to include a five-page form that soldiers fill out before meeting with a healthcare provider who does an assessment. Questions include whether the soldier has had sleep problems, was wounded, how he rates his own health and whether he thinks he was exposed to "any chemical, biological or radiological warfare agents."

The screening process for returned soldiers has sometimes been criticized.

"When you get back from deployment, you go to a big gymnasium with stations -- dental station, eyes and ears, vital signs -- and you have to get a check from every station to go home," said Graham Clumpner, a field organizer for Iraq Veterans Against the War who used to serve as an Army Ranger. "So you can imagine the incentive to tell the truth. You don’t want to be the squeaky wheel."

Soldiers can be stopped from redeploying to combat for many conditions, including having chronic illness "that would impair duty performance." Many injuries and illnesses may be allowable depending on their severity and effects. For instance, hearing loss may be allowable as long as the person can still hear well enough without an aid to perform his duties, the regulations say.

There are complicated guidelines about mental health disorders. Being bipolar or taking anti-psychotic drugs is a disqualifier. But a psychiatric disorder that is "in remission" or that doesn’t impair someone from performing their duties can be considered for deployment.

Each branch of the armed services has its own added guidelines. The Army gives a long list of conditions that would cause a soldier to be referred for more review before being sent back into combat, including suffering a stroke, epilepsy, glaucoma that resists treatment, and arthritis that interferes with duty.

If someone has suffered a brain injury, doctors are supposed to do tests to evaluate symptoms. The Army is starting to do neurocognitive tests before a soldier is deployed to get "baseline" data to compare if he later suffers a head injury, said James Giordano, director of the Center for Neurotechnology Studies at the Potomac Institute for Policy Studies.

However, "the scientific community has yet to identify an objective biomarker or other test that accurately determines when the brain has completely healed from the concussion/mild traumatic brain injury," Tolleson wrote. Instead, the decision relies heavily on how the soldier recovers from symptoms.

Someone with a medical problem that might bar combat duty could still be sent if the unit doctor seeks a waiver.

Any condition can be waived on a case-by-case basis, said Maj. T.G. Taylor, media relations chief for the United States Central Command, which covers most of the Middle East and Central Asian states. Although a medical official may grant a waiver, a commander may decide not to deploy someone anyway.

An Army memo states that the decision should be based on "whether or not the individual’s medical condition(s) place that individual at significantly greater risk in the deployed environment" and "whether or not the medical and other systems in the deployed environment can provide the support" if the person is deploying to the Central Command regions.

Gaps have been spotted in the system before: More than 43,000 U.S. troops listed as medically unfit for combat in the weeks before their scheduled deployment to Iraq or Afghanistan were sent anyway, USA Today reported four years ago. Some soldiers alleged that they had been sent into combat before they had finished medical tests for health problems, underwent needed surgeries or recuperated.

In rare cases, military recruiters under pressure to get enough recruits have been found to hide medical or other information that could stop an applicant from enlisting: More than 900 such incidents were alleged in 2005 when the U.S. Government Accountability Office took a look at the problem.